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# Iron Sucrose
## Overview
Iron sucrose is a parenteral iron complex indicated for iron deficiency anemia. It is a stable complex that dissociates in the reticuloendothelial system to release iron for erythropoiesis.
## Primary Indications
* Iron deficiency anemia in patients with chronic kidney disease (CKD), including those on dialysis and those not on dialysis (ND-CKD).
* Treatment of iron deficiency anemia in patients who are intolerant to or have failed oral iron.
## Adult Dosing
* **Hemodialysis-dependent CKD:** 100 mg administered either by slow IV injection (over 2–5 minutes) or intravenous infusion (over 15 minutes) during hemodialysis sessions. A cumulative dose of 1,000 mg is typically administered over 10 sessions.
* **Non-dialysis dependent CKD:** 200 mg administered by slow IV injection (over 2–5 minutes) or infusion (over 15 minutes) on 5 different occasions within a 14-day period.
* **Peritoneal dialysis-dependent CKD:** 300 mg via IV infusion over 1.5 hours at 14-day intervals (total 2 doses), followed by 400 mg via IV infusion over 2.5 hours 14 days later.
## Pediatric Dosing
* **Hemodialysis-dependent CKD:** 0.5 mg/kg (max 100 mg) every 2 weeks for 12 sessions.
* **Non-dialysis dependent CKD:** 0.5 mg/kg (max 100 mg) once every 2 weeks for 5 doses.
* **Peritoneal dialysis-dependent CKD:** 0.5 mg/kg (max 100 mg) once every 2 weeks for 3 doses.
## Dose Adjustments
* **Hepatic Impairment:** No specific adjustment; ensure regular monitoring of iron status.
* **Renal Impairment:** Dosing is specific to the dialysis status/CKD stage as noted above.
* **Dose limits:** Cumulative dose exceeding 1,000 mg should be administered with extreme caution; avoid iron overload.
## Contraindications
* Known hypersensitivity to iron sucrose or any of its components.
* Evidence of iron overload (hemochromatosis).
* Anemias not caused by iron deficiency.
## Adverse Effects
* **Common:** Hypotension, nausea, muscle cramps, injection site reactions, headache.
* **Serious:** Anaphylaxis/hypersensitivity reactions (monitor closely during and for 30 minutes post-infusion), iron overload.
## Key Drug Interactions
* **Oral Iron:** Parenteral iron may reduce absorption of oral iron; stop oral iron therapy prior to initiating IV iron.
* **Laboratory Interference:** May cause falsely elevated serum iron and transferrin saturation levels for up to 48 hours post-dose.
## Monitoring
* Monitor for signs of anaphylaxis during infusion.
* **Hematology:** Hemoglobin, hematocrit.
* **Iron Indices:** Serum ferritin and transferrin saturation (TSAT) to assess response and prevent iron overload.
## Clinical Pearls
* **Hypersensitivity:** Although iron sucrose has a lower risk of anaphylaxis compared to iron dextran, a test dose is generally considered unnecessary but clinical vigilance is mandatory.
* **Administration:** Do not mix with other medications or add to parenteral nutrition solutions.
* **Local Protocol:** Always check institutional policies, as cumulative dose calculations or infusion rates may vary based on local clinical pathways.
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**Educational Disclaimer:** This information is for educational purposes only. Prescribing practices and local guidelines may vary. Always verify current prescribing information, package inserts, and hospital-specific protocols before administering medication.
